EUS-guided Detective Flow Imaging (DFI) vs Contrast Enhanced Harmonic EUS in the Differential Diagnosis of Solid Pancreatic Tumors

Aims to evaluate the EUS-guided detective flow imaging (EUS-DFI) findings in solid pancreatic tumors (SPT) and compare them with those of contrast-enhanced harmonic EUS with Sonovue (CEHEUS).

Methods Prospective and descriptive study including patients with SPT who underwent an EUS evaluation. The procedures were performed using a linear echoendoscope (Fujifilm 740UT) attached to the ultrasound system Arietta-850. The lesions were classified according to the degree of vascularization using DFI and CEHEUS. The final diagnosis was based on EUS sampling and clinical and radiological long-term follow-up when histology was unavailable.

Results 149 patients (mean age 68.4 years [range 24-88 years], 68 males) were finally included. The average size of the lesions was 28.0±16.0 mm. 65 (43.6%) tumors were in the pancreatic head, 51 (34.2%) in the body, 23 (15.5%) in the tail, and 10 (6.7%) in the uncinate process. 89 (59.7%) patients were diagnosed with adenocarcinoma, 44 (29.5%) with neuroendocrine tumor, 8 (5.4%) with an inflammatory mass, 2 (1.3%) with pancreatic squamous cell carcinoma, lipoma and accessory spleen, and 1 (0.7%) with pancreatic necrosis and acinar carcinoma. The vascular pattern of SPT evaluated by CEHEUS and EUS-DFI, reached an agreement in 97.9% of cases. All adenocarcinomas, pancreatic necrosis, and pancreatic squamous cell carcinoma were hypovascular at EUS-DFI and CEHEUS. Inflammatory masses were isovascular at EUS-DFI and CEHEUS. Lipomas, accessory spleen, and acinar carcinoma were hypervascular at both CEHEUS and EUS-FI. All 44 neuroendocrine tumors were hypervascular at CEHEUS and 41 (93.2%) at EUS-DFI.

Conclusions DFI-EUS allows the evaluation of the vascularization pattern of pancreatic tumors with comparable accuracy to CEHEUS but without the need for contrast agents.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025